Does 4.5mg Naltexone come in a solid pill form?

I think the compounding pharmacy gave me 50mg naltrexone instead of the 4.5 mg prescribed. I have small, peach colored pills that have a b on one side and 50/902 on the other side. It was my understanding that this was a compounded drug and should be in capsule form. Any info is greatly appreciated.

Added 16 Apr 2014:

I finally got the correct 4.5mg dose. So far after 3 days on it I do feel that my pain level has decreased!

Responses (3)

Ultra-low-dose naltrexone can reverse or prevent the development of tolerance to opioids and is used off label for reducing tolerance and for fibromyalgia treatment, among other uses (it has been showed to help opioid induced constipation, it has been shown to make opioids work better-this has to do with the tolerance issue), often with an opioid using very low doses. They generally use 1mg to 8mg for low dose therapies. You are smart to question because if you are using opioids and you take 50mg it will thrust you into unpleasant withdrawals and make you very sick! You should contact your prescribing doctor and let him know then he can contact the pharmacy or you can.

For you Kaismama-for new learning info-I found this rather interesting and wonder why more docs arent trying it-Per an article I found on paintopics.org:Ultra-Low-Dose Naltrexone

The use of very small doses of naltrexone has gained some traction in the pain-treatment community. Orally or transdermally administered naltrexone in a 1 to 8 microgram (mcg) dose in the presence of ongoing opioid analgesia is too small to cause withdrawal in the majority of patients, but is high enough to bind to excitatory opioid receptors and prevent unwanted adverse effects, such as opioid tolerance, sweating, lower leg edema, itching, etc. Also, opioid antagonists in microgram doses seem to decrease “liking” by patients of pure mu-opioid agonists they are combined with, which reduces the prospects of opioid abuse in individuals taking such a combination. The use of oral naltrexone is more practical than naloxone for this purpose, since it is better absorbed in the GI tract.

Presently micro doses of naltrexone are not commercially available and physicians have to use compounding pharmacies for making such preparations. Preparing the compound is uncomplicated and involves 1 mg of naltrexone powder dissolved in 1,000 mL of sterile water, which makes a concentration of 1 mcg/mL. It is imperative that the compounding pharmacy adheres to the highest standards because a mistake in concentration of naltrexone may exceed the recommended micro-doses and initiate opioid withdrawal. Unfortunately, we have encountered this error on a number of occasions over the years.

We prescribe an oral dose of 1 mL (1 mcg) twice daily (b.i.d.) for a week with titration up to 8 mL (8 mcg) total per day in divided dose (4 mL, 4 mcg b.i.d.), depending on the patient’s response. The price varies from one compounding pharmacy to another but, on average, 120 mL of compounded micro-dose naltrexone costs about $30.00 to $60.00 for the patient per month, which is an out-of-pocket expense.

Positive clinical effects are usually obvious to patients with chronic pain who use such doses of naltrexone in combination with their usual maintenance opioids. The majority of patients invest in this medication and comply with the prescribed regimen either because of the sharp decreases in opioid side effects mentioned above or a desire to prophylactically avoid increases in opioid doses over time due to tolerance development.

Some combination products use naloxone instead of naltrexone. Our clinical observation is that the presently available preparation Suboxone® — combining buprenorphine + naloxone — produces a sizable clinical effect, which is reflected in the greater pain control and lower abuse rate of Suboxone® versus Subutex® (which is a pure buprenorphine preparation). We have observed in our practice that buprenorphine monotherapy (Subutex® or the Butrans® patch) provides less robust pain control than the buprenorphine-naloxone combination, and this is sufficiently noticeable clinically that we usually combine micro-doses of oral naltrexone (1 to 8 mcg) with buprenorphine patch therapy [see further discussion of this in an earlier UPDATE here].

Low-Dose Naltrexone

There are reports of small doses of naltrexone at 1 to 6 mg per day having beneficial effect in treating Crohn’s disease, interstitial cystitis, and other painful conditions. However, this dose of naltrexone must be effective on its own and cannot be combined with opioids due to precipitation of opioid withdrawal. In this case, the effects of naltrexone on pain, if any, are probably secondary to an improvement in underlying disease processes and are unpredictable.

Our clinical experience has not shown positive effects of low-dose naltrexone (2 to 6 mg/day) on pain in Crohn’s disease, multiple sclerosis, fibromyalgia, or interstitial cystitis in even a single patient. We have stopped using those doses in our clinical practice; although, it is possible that there is a certain sub-group of patients who respond to this treatment and are not present in our pain clinic population.

If this is what they are doing for you then someone screwed up and you shouldt take the medication especially if you are taking other opioids. It will make you deathly ill! Call the Drs office and make sure what dose he wrote for and let them know what they gave you. Hopefully they can get it straightened out! I would be willing to bet the compounding pharmacy isnt familiar with low dose naltrexone therapy and assumed your doc wrote it wrong and gave you the 50mg! See paragraph 3 in my comments where the article mentions that they find this mistake being made often!

I have done a lot of research of LDN (low dose naltrexone) and have been searching for an MD in CT who will prescribe it. If you look it up online it has some great reviews from FMS sufferers. Because it is given in "non-therapeutic" doses it benign. You ARE smart to have noticed you were given the dose usually given to people who have opioid dependence. It does not seem to have the same side effects as meds like Savella and Lyrica which I notice are not advertised as much on TV as they were. Please let us know how this works for you once you get the right dose. Good Luck! bruthd

That is great! I hope it works for you! I have been intrigued by this research. You'll have to post how you do after a few months! I have been on pain meds for years and have built up a pretty good tolerance. It would be great to knock some of that back so I could get by on less medication and still have relief!

Hi Kimvanover :) I was also prescribed LDN. May I ask are you taking any other pain medications? I have been taking it for a few months now... started at 1 mg at bedtime and increased by 1 mg every 7 days until I was up to 4.5 mg. Thing is my primary doc prescribed it for fibro/inflammation pain, but I was still on opioid pain medications prescribed by my pain mgmt doc for multiple chronic pain issues... so it was very unpleasant taking it at first as I felt the withdrawal symptoms when I would take it at bedtime since it was blocking the opioid meds I took in the evening. I have slowly been weaning off the opioid meds so as to see if the LDN really works. Are you taking it for fibromyalgia? And is it the only thing you are taking? I appreciate your response.

My primary wasn't prescribing it as a pain med, but as an off label medication that is being researched and showing some promise in treating autoimmune and inflammatory type conditions but getting the body to rely on its on opioid receptors and improve the immune system instead of suppress it. She just started me on it bf having my pain mgmt doc start weaning me from my opioid meds. Anyways kaismama, thanks.